Masada, which means “fortress” in Hebrew, is a place of history, defiance, triumph and tragedy all rolled in one. About three months ago, we had the chance to visit this place.

After Jerusalem, Masada is the second most visited site for tourists in Israel. This fortress became a symbol of pride for the Jewish people, as it was their last stronghold against the Roman invasion.

Masada is located at the western end of the Judean Desert. Sitting on top of an isolated rock plateau, with surrounding cliffs as natural barrier, it is understandable why it was so hard to conquer it.

Today, it does not shun intruders, instead it even invites guests to come for a visit. To get to this fortress though, you have to ride a lift.

There is also a trail going through stairs that you can hike from the bottom of the valley to the top of the cliff. This route is for the more adventurous souls, and definitely you need to be in excellent condition to go up this way.

After reaching the top, we feasted on the spectacular view around us.

Masada is overlooking the Dead Sea valley which is the lowest point on earth.

Photo below is the Dead Sea which is about 430 meters below sea level, while the height from the valley floor below to the Masada fortress is 450 meters. So even though it looks that this fortress is at such a height, in actuality, it is at sea level.

While we were on top of the cliff, we saw some paragliders sailing above the Masada fort. I would say this is far more cooler way to tour Masada, that is through a bird’s-eye view.

King Herod the Great built the Masada fortress as a refuge for himself. Not only as a fortress, but on the northern part of it, separated by a wall from the fort, is a residential villa for the king.

Below is what remains of a palace court.

Even what was left were ruins, it can be noted that this king’s palace was such a lavish place during its heyday. Photo below is one of the terraces of the king’s villa.

King Herod the Great found a way to bring water to this fortress. Not just that it was in the middle of a desert, but also bringing up water to such a high place took a lot of engineering, logistics and possibly enormous brute labor.

Below is what remains of a large bath house.

This specific room is the caldarium, where the suspended floor was supported by rows of low pillars, so hot air from the furnace outside, can be blown under the floor and through clay pipes along the walls, to heat the room to the desired temperature. In other words, it was the sauna! Who would have thought sauna was existing already more than two thousand years ago?

After Jerusalem fell to the Romans in 70 CE, a group of Jewish rebels, zealots, and their family, held the fort of Masada. According to history written by Josephus Flavius, the Romans established camp at the base of Masada, and the fort was laid in siege. The Romans constructed a ramp from thousands of stones and beaten earth against the western wall of the fortress. It was said that part of the ramp were bodies of dead Roman soldiers, who died during the battle.

Below is the photo of the ramp the Romans built to conquer Masada.

Finally in 74 CE, the Romans moved a battering ram up this ramp, and breached the wall of the fortress.

The tragic story of Masada was when the Jewish defenders realized that it was apparent that the fortress would fall and they would be conquered, they decided to commit a mass suicide. There were almost one thousand men, women and children. They chose to die from their own swords than be conquered.

Those Jewish defenders casted lots to choose 10 men who would kill the last survivors. And then the last Jew killed himself, before the fort finally fell to the Roman invaders.

Masada, a mighty fortress by a mighty people. Yes, it was breached and invaded. But never conquered.

The Filipino language is rich in interesting idioms and expressions, that make our conversations more colorful. Like the expression, “isang bulate na lang ang hindi pumipirma,” which means near-death condition. It definitely sounds light-hearted on an otherwise grave predicament.

Anyways, since it’s summer here where I live, and we have planted some vegetables, I would like to showcase our use of vegetables (gulay) in our idioms and expressions, and their respective meaning.

1. Nagmumurang kamias.

This means an “old” individual acting like “young.” For instance, a grandma trying to dress-up like a teenager, perhaps with a hanging shirt and short mini-skirt. In other words, it is used to describe people who are not acting appropriately their age.

The term means a good-for-nothing cop. I think the term is use, as policeman usually carry a baton (batuta). But here it is described as the police carrying a patola instead of a baton. There’s even an action-comedy movie with that title in the 1990’s.

The expression of “sundalong-kanin” have a similar connotation, a useless soldier whose only contribution in the battle is to consume the rice ration.

This term is used to describe something that is swelled up and inflamed, like a tomato that is plump and red. But mostly the term is reserved for a complication after a boy’s circumcision. Definitely you don’t want that term to describe the you-know-what after being circumcised.

Nangangamote means having difficulty or failing to do well. We also use the term kamote to describe somebody who is dim-wit or unintelligent. For sure, you don’t want to be called anak ng kamote. You don’t want to receive the kalabasa award either.

I am not sure why we use kamote as a derogatory term. Kamote for all I know is a highly nutritious food and don’t deserve to be treated with disdain.

Example: Nangamote ka naman sa exam, mas bobo ka pa sa row 4.

5. Mani-mani lang

This term is the opposite of nangangamote. Mani-mani lang means it was so easy that you breezed through it whatever it was. Again, I don’t know why we favor mani (peanut), but hate kamote.

Mani is also used as a slang term for a female’s anatomy. Yes, the counterpart of that thing I mentioned above that can become nangangamatis.

This is an old expression that means a fight or an argument without causing serious harm or consequences. As you know, a patani (lima bean), is a pod vegetable that has lightweight seeds. And even if you hit somebody with these seeds, it will not cause grave injury.

This term means a summary execution without having a trial. In other words it is extra judicial killing (EJK), which nowadays is a very hot topic of contention. The origin of the expression is that one way of hiding a “salvage” victim’s body is to dump it in the swamps or where there’s a heavy growth of kangkong (swamp cabbage).

This expression is comparing the complexion of someone’s skin to be like labanos (horse-radish), which is white and smooth. I am not sure though why we who are supposed to be proud to be lahing kayumanggi are so pre-occupied and trying so hard to be “white.” Just look around and we are so inundated with all those advertisements of whitening products.

Unlike the expression mala-labanos which is mostly deemed as a compliment, the expression parang luya is far from being one. In fact it is an insult. The term is usually used to describe an ugly feet. This is due to the fact that luya (ginger) has crooked and contorted branching fingers.

This term is used to describe a person that is easily hurt or sensitive to criticisms. This idiom is due to the fact that the onion has very thin skin. I am not sure if the added fact that peeling and cutting onion makes one cry, contributes to the meaning of the term.

That’s all for now folks. I know there’s still a lot of vegetables mentioned in the song Bahay Kubo that we have not covered here. So if you know more vegetable expressions, please drop me a comment. Thank you for reading.

It’s summer here in our place. Well, not quite officially, as the summer solstice is not until June 21 which marks the official start of summer in the northern hemisphere. Yet the mercury is rising, as our high temperature for the past few days and the coming week will be in the 90’s to even reaching 100 º F.

But this morning, it was a comfortable 74 º F, so I went out for a run. It is also about this time of year that I should start preparing for the half marathon, if I should decide to join again this coming fall.

As I was approaching the small pond in my running route, I have to stop and let the family of geese get off the road before I could pass. The mother goose was already hissing at me as I was approaching them. They can be very territorial you know. But that’s fine, I can share the road with them, and I have no plans on swimming in their pond.

When I came to the wooded areas, I also saw a deer. But it bounded quickly away before I could take out my phone out of my pocket to take a photo. It might be sneering at me that I am too slow.

Same thing happened when I came to an area where a couple of wild rabbits were on the side of the road foraging for food. They also scurried away at the sound of my slow feet, before I can get near them. They may also laughing at me for being slow.

I admit, I am getting slower. Maybe my age is catching up on me. I have no match for the swiftness of the deer and the hare. They seem to dash so effortlessly and yet so gracefully. While me, I push for every step of my way to get to a pace that runners would even consider “running.”

Maybe all of us can relate in one way or another, and in different endeavors, that we feel we are no match to the “competition” we are going against. Whether it be in sports, or in school, or in our work, and in life in general.

Then as I was fighting my way uphill, I saw this guy.

Yes, that is a snapping turtle. And I was “quick” enough to take a photo of him.

They are called snapping turtles not because they snap their fingers as they go, rather they have the ability to snap, as in bite an attacker. That’s why I kept my distance.

The pond, or any body of water that I know in this area, was hundreds of meters away. I don’t know how long it would take him to get there, if that was where he was heading. But I’m sure his slow pace does not stop him from continuing, for that’s who he is.

It gave me a good insight for the day. Life they say could be like a race. But it is not always for the swift, but to those who kept on running.

It is my third time to visit Boston. This time I came to Boston to catch up on sleep.

No, I’m not saying that Boston is a sleeper city, for it is an exciting place to visit. Nor am I’m saying that it is a place most conducive for sleeping. In fact since we stayed in a hotel in the heart of the city, it was quite noisy, with all the cars honking and with loud police and ambulance sirens wailing. Added to that, we landed past midnight in Boston, contributing to my sleepy predicament.

Why I came to Boston is to attend a conference to catch up with the current studies, trends and technology in the practice of Sleep Medicine. Honestly I nap a little in some of the lectures, so I literally catch up on my sleep too!

theme poster of the convention

The science behind sleep has fascinated me since I was in high school, so it’s not a surprise that one of the subspecialty I pursued was on this field.

One of the fascinating sleep phenomenon that I wanted to learn more of are the Parasomias, which includes nightmares, night terrors, sleep walking, and more that goes bump in the night.

One Parasomnia is REM Behavior Disorder (RBD), in which people with this disorder reenact their dreams. Normally when we are in REM (Rapid Eye Movement) stage, a sleep stage when dreams usually occur, our muscles are disengaged and we are temporarily paralyzed, so we don’t move and act out our dreams. In people with RBD, for some reasons the muscles are not paralyzed, so they can kick, swing a punch, crawl out of bed, or even perform a complex activity while sleeping. Not only this put the patient in danger, but also the sleep partner.

One interesting fact I heard from one lecturer is that soursop which is a tropical fruit, or also known as guyabano in my home country, the Philippines, can potentially increase the incidence of RBD. I can almost read a headline news: sleeping wife punch husband, after drinking guyabano punch.

opening session

Besides the medical implications, there’s also societal implications of people having poor sleep. These are also topics discussed during the convention.

Research have shown that birds can sleep, as half of their brain can go to sleep, while on long flights. But not humans. We need all our faculties when we are doing complex task like flying a plane. Though aviator Charles Lindbergh, the first man to cross the Atlantic on solo flight was awake for more than 34 hours when he accomplished that feat, nowadays we have instituted regulations for pilots limiting their hours of flying and assuring they have a sufficient amount of sleep in between flight.

Same principle applies with operating any machinery or driving any motorized vehicle. Studies have shown that a significant number of vehicular accidents are due to driver fatigue and sleepiness. For instance a sleepy driver can have a slower reaction time. A decrease of even 50 milliseconds in reaction time in hitting the brakes means 5 feet more before coming to a stop, and that can mean safely stopping or crashing, or escaping an accident or dying.

For the medical community, especially the ones who are undergoing residency training, there’s now an imposed 16 hour limit for a first year resident for continuous work. Beyond that they should be relieved, for they need to go to sleep. During my residency training in the mid 90’s, the limit for continuous hospital duty was 30 hours. This regulations though are not enforced to doctors after they are done with their training.

We as a community really need to change our opinions. Staying awake all night to study or pulling an all-nighter to finish the job has become a badge of honor. We view sleep as only for slackers. When we should view that those people who get adequate sleep, that is 7-8 hours a night, should be the ones commended. So no more sleepless in Seattle, or Boston, or New York, or Tokyo, or any part of the world for that matter.

Just like when you’re hungry, the solution is to eat. For people who are sleepy the solution is not more coffee or energy drink, but getting adequate amount of sleep. Of course if you have a sleep disorder and not getting a restful sleep then you need to see your doctor.

Sleep is important in so many levels. Not only for health but also for safety and being more productive. In addition, dreams come when we sleep, and life without dreams would be uninspiring.

During our ICU morning rounds, the medical residents were presenting the patients’ cases to me as I was taking over care from another attending physician.

One of the patients came in with fever and worsening shortness of breath. After work-up he was diagnosed with Legionnaire’s disease, a severe infection by a water-borne bacteria . He had complications with multi-organ failure, requiring mechanical ventilator and dialysis, among other life-sustaining support. After more than a week, he improved.

So as the resident was presenting his case with such bravado, he concluded with the statement, “we snatched him from the jaws of death,” with matching clawing action, like the arcade game of claw crane.

I kind of smiled with his presentation. I know he was half-joking, just to lift the morale of the ICU team. Taking care of very sick patients in the ICU where mortality is quite high despite of all the efforts, can be depressing.

I know this resident is a smart guy. In fact he is finishing his Internal Medicine residency with us in another month, and will be continuing his training in Hematology-Oncology Fellowship at Mayo Clinic this July. Maybe he’ll be “snatching” more patients from the jaws of death.

But there may be some truth in his statement, as we are literally snatching people out of the jaws of death. But are we really? Or are we just kidding ourselves?

That afternoon, there was a Code Blue (medical emergency) that was called overhead and my ICU team ran to respond to that call, which was a little ways out, as it was in the annexing building at the outpatient Cancer Center. The Intern (1st year resident), the most “inexperienced” of my team was the first one to arrive at the scene. He immediately took helm and directed the resuscitation efforts. Of course he was more than able and certified to do so.

By the way, even though some may say that residents (doctors-in-training) can be inexperienced, in a recent study published last month in the Journal of the American Medical Association, it reported that patients’ mortality rate is lower in teaching hospitals, than non-teaching hospitals.

Back to my ICU team, after more than half an hour of furious CPR, a stable heart rhythm was finally attained. The patient was then admitted to our ICU. I commended the Intern for doing a great job with such poise and calm, even in the midst of chaos during the Code Blue. Borrowing the words of my other resident, I told him in a jest that he “snatch” one out from the jaws of death.

I know from my experience, that even though CPR was “successful,” it was only temporary. Given the fact that this particular patient has advanced cancer, and was receiving chemotherapy when she had the cardiac arrest, tells me that the prognosis was poor.

I spoke with the patient’s son and explained to him the situation, that even though we were successful in reviving her mother, still the odds of her surviving through this was slim. But the son wanted “everything” done including doing more CPR if in case her heart stops again and does not want to hear about the poor outcome. But I understand, it is hard to let go.

The next morning, I learned that our cardiac arrest patient died. She died a few hours after I left for the night. So much of snatching people from the jaws of death.

Before we can start our ICU rounds that morning, my ICU team was called to the Emergency Department (ED) for a CPR in progress.

When I came to the resuscitation room in the ED, I saw a patient with the Lucas device on him (a machine that do the automated cardiac compression). I was told by the ED physician, that they were trying to resuscitate the man for about an hour now. He would temporary regain a heart beat, only to lose it again.

Lucas device (photo from web)

They called me to assess if we should place the patient on Extra-Corporeal Life Support (ECLS), a “heart and lung” machine, as a temporizing measure to save him (see previous post). I suggested we call the cardiologist too.

Shortly thereafter the cardiologist arrived, and as soon as he walked in, the patient regained a stable heart rhythm again. So the Lucas device was shut off temporarily. After a brief conference with the cardiologist, we decided that the he would take the patient to the Cath Lab and see if he can open any blocked coronaries. Then we’ll decide if we need to hook the patient on ECLS.

Less than 10 minutes after we hashed our plan and as we were preparing to take the patient to the Cath Lab, the patient’s heart stopped again. We turned on the Lucas device once more. Our resuscitative efforts was now close to an hour and a half.

That’s when we all agreed, the cardiologist, the ED physician, and me, to call off the code. This patient was too far along from being snatched from the jaws of death.

We turned off the Lucas device, unhook him off the ventilator, and stopped all the intravenous medical drips that were keeping him “alive.” The ED physician then went out of the room to speak with the patient’s family, while me and my ICU team went to start our morning rounds and take care of our ICU patients.

It was grim start of our morning. Definitely my team was feeling down again.

Two hours later, I got a call from the ED. On the other line was the cardiologist, and I cannot believe what I was hearing. He was asking me to admit to the ICU the patient whom we pronounced dead earlier that morning!

Apparently after we unhooked the patient from all life-sustaining device, he regained a stable heart beat, and he started breathing spontaneously. They were waiting for him to die for the past two hours but he did not.

When I told my team that we were admitting “Lazarus,” which was what I called the patient, they thought I was just joking to lighten the mood. It took me a little more convincing for them to realize that I was telling them the truth.

That tells me enough of this “snatching people from the jaws of death.” Some of them can get out, even if we already dropped them. It just show who is really in charge. Definitely, it’s beyond us.

Post Note: since a reader asked, here’s the English translation for my non-Filipino readers and followers:

Dew
Like a blanket that covers the shivering grass,
Or a heavy cloak that the surrounding it wraps,
Or like a curtain that veils the sun’s glare,
Are the clouds that court and kiss the earth,
Just like love is like the dew to hearts that thirst.